Healthcare data ownership is an important issue and I was pleased to run across Pardalis, a company specializing it. Although they don???t focus only on healthcare, they intrigued me because they appear to be a cross between a nascent supply chain Google, eBay, and author-controlled Wikipedia. That is, they claim to be able to increase availability of on-demand healthcare information (which lots of companies are doing) but they provide real-time control over the process of sharing such information to patients and healthcare information producers (which very few allow today). It???s unique enough that they???ve recently been awarded a couple of patents. Pardalis is company worth keeping an eye on because if they can achieve even part of what they plan it could lead to a practical realization of software as a service that might give more than just lip service to privacy and be able to address the economic realities of ???data ownership???. I invited Pardalis??? founder and CEO, Steve Holcombe, to discuss why he believes healthcare informatics seems be trapped within a technological Tower of Babel. Here???s what Steve had to say:

Shahid, in this Age of the Internet, patients and consumers are asking how they can easily and securely access and share their personal healthcare information as and when they choose.

Hospitals, healthcare clinics, physicians and other healthcare service providers know that there is no sense in developing a healthcare informatics infrastructure to merely warehouse healthcare information. They also understand that building one huge, integrated informatics infrastructure is impractical, to say the least, and probably impossible in terms of getting everybody to first agree on a common set of standards. But they too are nonetheless asking themselves how they can share the patient information they hold in trust between their respective ???information silos??? in a manner that provides them with a direct, on-demand choice to audit and control the use of such information in compliance with HIPAA.

The ever increasing reliance upon the Internet in general commerce, the increasing usage of unique identification as applied to pharmaceutical products, and the longtime use of unique social security numbers for identifying patients have converged to raise the level of expectation for on-demand, confidential sharing of information by healthcare information producers and patients. But the political and economic question of ???Who owns my data???? is not being answered to their satisfaction and the result is untold quantities of missing, incomplete and untrustworthy information along the complex healthcare supply chain.

Neither enterprise systems, ERP systems, nor web services have assuaged the cacophony of disparate healthcare information technologies that is today???s status quo. Yes, healthcare informatics as it presently exists is seemingly held hostage within a technological Tower of Babel.

Why isthis so? Probably for the very best of reasons. Existing enterprise systems, ERP systems and web services all manipulate two-dimensional rows and columns of data sets and/or two-dimensional compositions of data objects. It is reasonable for software engineers to make one-step, iterative improvements to the existing systems to securely provide for the sharing of information without giving technological consideration to complicated, three-dimensional political and economic issues. That is, it is reasonable for the software designers to presume that some day the appropriate industry standards will eventually be hammered out and everybody will just ???do the right thing??? in terms of information sharing. It is reasonable for technology officers to think only in terms of getting two-dimensional data sets or data objects from point ???A to Z??? The curious thing is that the cumulative weight of these reasonable decisions have brought us to where we are today.

The short answer to this overwrought, two-dimensional reasonableness is a technological three-dimensional radicalism.

Mind you, leave the existing two-dimensional data systems in place. It is one thing to be radical. It is all together another to be foolish. But in thinking about designing a solution for integrating the existing two-dimensional systems, consider addressing first the political and economic issue of ???data ownership??? as also a three-dimensional technological challenge. That is to say that the methods that must radically be addressed before any source code is written should provide the choice of on-demand ???data ownership??? for every patient and healthcare service provider along the complex healthcare industry supply chain.

Here???s the premise. Radical methods of data ownership must add a sophisticated framework for virtually integrating the participants along the healthcare industry supply chain so that they can easily and cost effectively search for and find in real time - permission being granted by the information owner, steward or custodian - just what they are looking for to make better informed healthcare judgments or increase profits.

To lay a three-dimensional foundation for achieving this premise, consider the dynamic combination of these three characteristics:

Unique identification of every authored data element,

Immutability of every authored data element, and

Permanently attributing the identity of the each information producer to each immutable, authored data element

The result is an electronic pedigree per data element that adds a third dimension of ownership to existing two-dimensional data sets and data objects.

How might this be practically accomplished? Think of a centralized, organically flexible database containing a ???dictionary??? of uniquely identified immutable data elements. No matter in what data format the healthcare information is originally authored, its import and re-authoring at this central database with these uniquely identified, immutable data elements would drive standardization through the common use of the same healthcare dictionary of data elements by the supply chain participants. Furthermore, the granularity of three-dimensional, uniquely identified data elements would provide the choice of unmatched flexibility in their sharing.

Other than three-dimensional standardization and granularity, why else would participants along the healthcare supply chain be drawn to this central dictionary? For a dynamic combination of one or all of the following reasons (which I by no means consider to be a complete list):

the opportunity to directly transform intangible healthcare information into something much more tangible and, as a result, potentially more valuable

the opportunity to bank and use healthcare information in real time in some respects like how we bank and use our own money

the trustworthiness of immutable healthcare information including professional validation as part and parcel of its e-pedigree

the ability to license temporary access to one or more healthcare supply chain participants, and to track and follow the usage of such information in real-time.

the ability to permit access to healthcare information without giving up one???s confidential password

the opportunity by healthcare data owners, stewards and custodians to retain long-term control over data mining

Shahid, thanks again for the opportunity to comment on your blog. For those readers in the San Francisco area, I will be there the week of February 15-19, 2007 to attend and present at the annual meeting of the American Association for the Advancement of Science. For more information, click here. If any of your readers would like to explore an opportunity to meet with me personally, I can be reached directly at steve@pardalis.com.

At first glance it would appear that this is a silly question. Anyone who has experienced heartburn knows that it is caused by stomach acid moving into the esophagus (the tube that food travel into our stomach). This might not be as straightforward as we once thought.

Forty-four percent of the population suffers from some type of indigestion. This should come as no surprise, if you have turned on your TV in the last 10 years. Plop, plop, fizz, fizz, How do I spell relief etc. have become household phrases due to the ubiquitous nature of this condition.

The function of stomach acid is to add in the breakdown of large food particles that are ingested. In order to get the proper nutrients out of our diet, it is imperative that the food we eat is broken down prior to moving into the intestines. If there is too little stomach acid, the large food particles sit in the stomach for an extended period of time, instead of being passed quickly to the intestines for nutrient absorption. This undigested food will back up in the stomach and start to push its way up the same tube that it came in, created symptoms of burning and discomfort.

When symptoms of pain and discomfort appear, the most common corse of action is to take an over the counter alkalizing agent such as Tums or Rolaids to decrease the acidity of the stomach acid. This will decrease the symptoms, but it will not address the underlying issue if you are deficient in stomach acid.

How do you know if you have too much or too little stomach acid?

One test for stomach acid is called the Heidelberg Stomach Acid Test. This test is a high tech and performed in a physician’s office. In this test the patient swallows a capsule that measures the level of stomach acid and transmits the information back to a computer, for more information on the Heidelberg Test click here.

Another more low-tech test involves adding vinegar to your diet and watching your symptoms. Vinegar has a low pH, which means that it is highly acidic similar to your stomach acid. If you add a tablespoon of apple cider vinegar to your meal and your symptoms of indigestion decrease, it is likely that you have low stomach acid.

What can cause low stomach acid?

There are a number of things that can cause your stomach acid to decrease. Stress and long-term medication use are some of the most common. Also, as we age our stomach acid decreases, which explains why more people develop indigestion as they age.

Is this a serious condition?

Low stomach acid alone is not thought of as a serious condition, but the overall effects of this condition on the body are thought to be very serious.

If you are experiencing the symptoms of indigestion seek the advice of a trained professional. Practitioners of natural medicine are likely to be your best resource for this type of help, although there are a growing number of medical practitioners who are specializing in this area. If you would like a referral to a practitioner please contact me.

If you were to ask those cute little penguins from “Happy Feet” the movie they would tell you the best way to prevent the flu is with a flu shot.? I have a feeling the pharmaceuticals that paid for the advertising would agree with them also, but CDC has something different to say about the effectiveness of the flu shot, for the report click here.

The Pharmaceutical companies have been very effecting in “educating” the American public ofthe danger associated with germs, like the influenza virus.? We are led to believe that everyday is a game of hide and seek from these little monsters.? These little monsters are everywhere and there is no hiding see my post Germs-You Can Run But You Can’t Hide.

The only way to prevent the flu is to keep your defenses up.? The immune system is responsible for protecting the body from foreign invaders.? When it is weak the opportunistic vaccines come in and set up shop. How does the immune system become weak?? Stress, lack of exercise, bad diet, smoking, drinking etc.? If that doesn’t sound like the holidays, I don’t know what does.? Viruses could care less what the temperature is outside.? The reason people get sick has nothing to do with the weather, it has everything to do with the state of your immune system.

Have you ever wondered why you get sick and your spouse doesn’t?? Did you know that there can be as many as 10,000,000 germs on your desk?? Germs are everywhere!

Simply put, exercise, eat well, decrease stress in your life if you want to prevent the flu.

Steam inhalation is a wonderful way to remedy respiratory problems such as chest congestion, sinusitis, bronchitis and bronchial cough. It is easy to do and very cost-effective: simply bring a pot of water to boil on your stove, then stand over it and drape a towel over your shoulders. Be careful not to get too close to the steam, and that the towel does not touch the flame or burner on your stove. Try to breathe through your nose if you have nasal and sinus problems; if you are too stuffed up, breathe through your mouth with your lips pursed. The steam will help keep nasal passages moistened and relieve some of the aches and pains associated with respiratory problems.

Once you have the steam tent set up, consider enhancing the effectiveness of steam inhalation with aromatic herbs. Some favorites are sage and eucalyptus, which can make the steam more soothing. These herbs are also antibacterial and using aromatics in this manner can help to reduce the chance of secondary bacterial infection when respiratory diseases are caused by viruses. You can add sage or eucalyptus to the boiling water by the whole leaf or as an essential oil - try a teaspoon of the oil, or a small handful of the leaves. Both are available at herb shops and natural food grocers.

I was recently interviewed by For the Record magazine about why many hospitals and their CIOs are choosing to bring their IT projects inhouse. Here’s how Elizabeth Roop began the article:

It may be too soon to call it a bona fide trend, but there is a change underway within some hospital IT departments, where they are bucking tradition and handling projects internally rather than outsourcing them to vendors or consultants.

The reasons vary. In some instances, facilities want to maintain better control over what they consider the most important aspects of their IT infrastructure. In others, it???s a desire to reduce reliance on vendors for ongoing maintenance and, in some instances, to reduce costs.

Elizabeth’s premise was interesting and I was happy to provide my thoughts on why it makes sense not to outsource IT in some cases (especially when it’s a strategic requirement).

Let me know what you think about it and whether you agree with my points.

I was recently interviewed by For the Record magazine about why many hospitals and their CIOs are choosing to bring their IT projects inhouse. Here’s how Elizabeth Roop began the article:

It may be too soon to call it a bona fide trend, but there is a change underway within some hospital IT departments, where they are bucking tradition and handling projects internally rather than outsourcing them to vendors or consultants.

The reasons vary. In some instances, facilities want to maintain better control over what they consider the most important aspects of their IT infrastructure. In others, it???s a desire to reduce reliance on vendors for ongoing maintenance and, in some instances, to reduce costs.

Elizabeth’s premise was interesting and I was happy to provide my thoughts on why it makes sense not to outsource IT in some cases (especially when it’s a strategic requirement).

Let me know what you think about it and whether you agree with my points.

I’m a big proponent of software as a service (SaaS), application service providers (ASPs), and related “online application” technologies. Online applications make great sense in healthcare because of the network effect: they are inherently collaborative, they are designed for integration, and easy to install and begin using. However, we’ll have to solve the following problems before we can really call online apps a success in healthcare settings:

Application availability offline — online apps aregreat but what happens if there’s downtime? In healthcare we need “always on” and high availability; if you use online apps what’s the offline usage strategy?

Data Ownership ??? what kinds of contracts, pricing, privacy, and other mechanisms are available to ensure that my data stays mine? If the online company ever goes out of business, is sold to someone else, or I ever want my data back without anyone else having a copy how would that happen? Who owns all this data in an online app is a big question and big problem that we need to resolve. How can you get your data in backup format that you could actually use?

Single sign on (SSO) — in our hospitals we’ve strived to give our caregivers and front line users a single security credential with roles that could give them controlled access without remembering dozens of passwords. Most of us don’t have single sign on in our enterprises but are working towards it; with online applications we’ll be back to square one so what’s the identity management strategy that will allow online apps to be tied into our SSO implementations? Another problem is account provisioning — how do you establish that process on someone else’s system through your current help desk?

Billing and usage — the more online apps we have, the more usage and billing will need to be tracked. What type of consolidated reporting and billing will be available to make sure that our finance folks can handle the apps?

Workflow and business process integration — online apps are usually task oriented but they don’t integrate well with existing business rules, workflow, and policies. What standards can we start using to make sure that multiple online apps from a variety of vendors can start to talk to each other without us having to do all the integration work?

What do you think? What other major problems need to be solved before online healthcare apps become mainstream?